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Home My WebLink About4037DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -1 BOX 31 ism ,.�� T I �r 1 :6 1 r T., r 04037 q7 u- new T, PUI'NAM COUNTY HEALTH DEPAR'IIMENT DIVISION OF ENVIRO *WCAL HEALTH SERVICES v to S GE'DI5POSAI, SYSTEK REPAIRv OWNER'S NAME `� �A K Z ��O PHONE �o� A 3 P i`e h r (4 C Z SITE LOCATION !Z L4(ec- n 24 y r, - To 93 S C --t;2 ' f MAILING ADDRESS tj+lZC 21 ez (c��L'i < < , 1 �.� , j 0 S ?i PERSON INTERVIEWED PCHD Canplaint # Name &Relationship (i.e, owner, tenant, etc.) R� DATE TYPE FACILITY PROPOSED INSTALLER 6 fz" •T, PHONE C L ,S'9 r REGISTRATION # Pro (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. - - - - _ - -- — - __,,W_ r!2 -_ P- o LAe e -)((5 -r, k 6 I't CC, n f Sri -Aurc Proposal approved Inspector's ture & Title aff NOT Lv q. cc Proposal Disapproved 'roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. [, as owner, or reported agent of owner agree to the above conditions. SIGN xun TITLE , / '%� DATE �t US: White (P iD); Yellow Ckwn ED; Pink (Aa2 iamt) Supervisor KENNETH CARLSON Town Clerk & Tax Collector GWENDOLYN LOGAN Town Attorney ALFRED SKLAVER Town Justices 6 46 HARVEY A. TAVE JOHN C; SOARERS PUTNAM COUNTY, NEW YORK April 22, 1971 Putnam County Board of Health Carmelq New York 10512 PHILIP J. KEATING J. ROBERT HOUSKEEPtR Re: Leopold Strauss Lake Drive, Lake Peekskill BL5 L95-97 Gentlemen: The above subject, Mr. Strauss, has appeared before the Town Board requesting-relief in.order to d.ig -.. a ..well on his proprt.y -on- -.5 95-9.7-, ..Lake--brive, . Mr. Whitehill, our Building,Zoning & Sanitary Inspector has refused him a permit to dig the well as he does not have the required footage from the neighbors, septic fields. The Town Board therefore requests that you kindly make an inspection and return your opinion to them at the earliest possible time. Yours very truly, T ,n Cle6K V ms cc:Mr. Whitehill 4* WLLL UU1v1rLt,11U1y AmiruAl DEPARTMENT OF HEALTH Div7. ision Of Environmental Health Services , . PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - WELL LOCATION STREET AOURESS: IEWN/ViCLACIT111' TAX GRID NUMBER: V( rig /-a 4MM UCLae- H WELL OWNER . NAME. ADDRESS. I 2_ . �, f 'To _C4_ EVa V, qq_ Le A, Q!L PBIVATE 0 PUBLIC USE OF WELL 1- primary 2 - secondary R R _ESIAENTIAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED I-OT-3 7 0 BUSINESS ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST OF DAILY USAGE 6 0 gal. REASON FOR DRILLING INREPLACE EXISTING SUPPLY []TEST/OBSERVATION []ADDITIONAL SUPPLY ANEW .SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC WATER 'LEVEL ft. DATE MEASURED L —149 DRILLING EQUIPMENT ❑ ROTARY IR COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING 03 OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH ft MATERIALS: IR STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED (I THREADED 0 OTHER DIAMETER --7— in. SEAL: SLCEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT - Ib./ft. I DRIVE SHOE- $a YES ❑ NO I LINER: 0 YES V NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST 0 YES ONO --HOURS- SECOND GRAVEL PACK 11 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP I OEM ft. BOTTOM OEM — it., WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- I& COMPRESSED AIR formation attached? O BAILED ❑ OTHER 0 YES 0 NO If more detailed formation descriptions or sieve analyses WELL _ LOG are available, please attach. DEPTH FROM suRFAcE Bear- ing Weil Dia- meter In FORMATION DESCRIPTION CODE ft . WELL DEPTH it. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land Surtace 0, aa.4_ /V 14 -n 11 iG C-Acul 4QA01 P& U WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY GAIT. WELL DRILLER NAME -P eyt _Ct� C6 _-Mu ADDRESS Vb 5, SIGhtTURE c CLYL � il PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE — HP 3/89 L IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. DATER WELL CONTRACTOR: Name.1,04d ajtfij Lao TRW r" t,u .c Address: bvt2 a-- IS PUBLIC-WATER SUPPLY AVAILABLE TO SITE: YES NO 'Y OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY L.' . %.?. TO PROPERTY ' FROM NEAREST WATER MAIN: w CH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (sign ture) PERMIT TO CONSTRUCT A WATER WELL well as set forth above is granted under the provisions York State Sanitary Code, and provided that within -titer well construction, the applicant shall: the requirements of the Putnam County Health .1 provided by the Putnam County Health Department. scant shall take appropriate action to assure that :j _h well drillin operations be contained on this grade or othe se contami.11ate surface or groundwater. J Permit Issuing Official White copy: HD File = SAOE Imo' foposed NQu.). Wo-%l K w,• .. •.iii;' <n�1�•'� "�'. I 'K, LaCt� mil. ��ve� ;zl--";;,•-;. aM COQ. WILL UU1`1rLL11U1N MEXUr%l DEPARTMENT OF HEALTH rgpylronmental Health- Seryi_ es.- PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET ADDRESS: TOWNIMMETICIry TAi GRID NUMBER: r7 . 9 1-NQ PQ+VWLM V CL ftQ_ q 93tr �- 1-1. WELL OWNER NAME: ,To.cj " vi -2- I—ake Im i Lk, 2,00ka EA 11 Y 9 PGIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary R_RESIANTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED 11) 7 0 BUSINESS ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL. ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING [@REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION []ADDITIONAL SUPPLY []NEW SUPPLY (NEW DWELLING) DDEEPEN EXISTING WELL DEPTH DATA WELL DEPTH EIS ft. STATIC WATER LEVEL MEASURED DRILLING EQUIPMENT 0 ROTARY 9 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT .0 CABLE, PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING 91 OPEN HOLE IN BEDROCK 0 OTHER CASING TOTAL'LENGTH ft MATERIALS: 54 STEEL ❑ PLASTIC 0 OTHER LENGTH BELOW GRADE 9 ft. JOINTS: 0 WELDED Gi THREADED 0 OTHER DETAILS DIAMETER in. SEAL: NXEMENT GROUT 0 BENTONITE O.OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE: 9 YES ❑ NO I LINER: OYES I0 NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST P YES..O.NO:. SECOND HOURS GRAVEL PACK 11 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK — in. TOP DEPTH —ft. BOTTOM DEPTH — It.' WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is it.- %K COMPRESSED AIR formation attached? 0 BAILED 0 OTHER 0 YES C3 NO -111 more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE. Water Bear- ing Well Oia- meter In FORMATION DESCRIPTION Coal! it . ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. La n Surfad ce ew .�hd_ Ao q4-- Flip p- jq WATER ❑ CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES ONO STORAGE TANK: TYPE CAPACITY GAT,. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE — HP — I WELL DRILLER NAME - TL ADDRESS PK—b S SiGiMME C 0 0 F1 ;7��/ 3/ UY 31111 I� k 1 440, DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 - AIsPF,T y' TICi R PCHD PERMIT WELL LOCATION Street Address T Villagez it Tax Grid Number WELL OWNER Name �8 �ha v►�. Malin ► ( ::.: Address $ s L Wrivate o 3 i 0 Public USE OF WELL 1 - primary 2 - secondary RRESIDENTIAL ® BUSINESS ® INDUSTRIAL ®PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP C7 AB O FARM;' O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT S' gpm /4 ® REPLACE EXISTING SUPPLY• O NEW SUPPLY NEW DWELLING) c 'P vL U PEOPLE SERVED ` /EST. OF DAILY USAGE ,5_00 Sal O TEST /OBSERVATION 13. ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL r'6-u • c - N 4'-0 wuj I&Q, REASON FOR DRILLING DETAILED REASON FOR DRILLING 1-L Re t st . Q WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES K NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �_N0 a as -3 fRb NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE. TO FRO .PROPERTY- M::NEAREST--WATER 'MAIN:, LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET 1_ 2 (�;)_ I �. -3 •-s(�- VG (date) (sign ture) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirti, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drillin operations be contained on this property and in such a manner as not to degrade or othe se contam' ate surface or groundwater. Date of Issue: 19 ��/ Date of Expiration 2.- 19r Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller